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Pain-pill prescription rates have risen in Mohave County and other rural Arizona counties over the past decade, according to the U.S. Centers for Disease Control and Prevention.(Photo: Kingman Chamber of Commerce)

The vast rural county in northwest Arizona dispensed 127.5 opioid prescriptions per 100 residents that year, making it Arizona's most prolific county by that measure, according to the Centers for Disease Control and Prevention.

The CDC data shows that Arizona's rate of 70.2 opioid prescriptions per 100 people is slightly above the U.S. average of 66.5 per 100 people.

While the figures show that pain-pill prescriptions in Arizona dropped nearly 10 percent over the past decade, they have continued to rise in Mohave County and other rural counties such as Cochise and La Paz since 2007. No data was provided for Greenlee County.

The CDC data, based on a sample of 59,000 pharmacies nationwide, provides only a ratio of total prescriptions per 100 residents. It doesn't show the number of pills prescribed or the number of people with multiple prescriptions.

Still, the data jibes with what Mohave County health professionals and law enforcement see daily with powerful, addicting opiates such as oxycodone and Percocet widely available in the county of 200,000 residents.

"We have known if for quite a few years," Rusty Cooper, deputy chief of the Kingman Police Department, said of the prevalence of opioids in the community.

The Kingman Police Department was the first in Arizona to implement a training program for its officers to carry opioid overdose-reversing naloxone. Agencies across the state have since implemented the training.(Photo: Jason Pohl/The Republic)

That is one reason why the Kingman Police Department was the first Arizona law-enforcement agency to train and equip patrol officers with overdose-reversal drug naloxone.

Cooper said officers have reversed five overdoses since the department began to train and supply officers with naloxone in August 2016. The first person Kingman police saved from an overdose recently graduated from the Mohave County drug court program, which connects drug-dependent individuals accused of non-violent crimes with treatment programs.

"It was good to see that result with somebody that we helped," Cooper said.

State efforts to fight crisis

Gov. Doug Ducey has made the availability of naloxone a centerpiece of his efforts to combat the opioid epidemic.

Since the Republican governor declared a public health emergency last June to combat the opioid epidemic, the Arizona Department of Health Services has trained more than 1,200 first responders to carry naloxone and distributed more than 5,100 naloxone kits to law enforcement.

On Friday, Ducey signed the Arizona Opioid Epidemic Act, a sweeping bill unanimously approved by the Legislature. The bill will impose prescribing restrictions, fund addiction treatment and distribute naloxone to county health departments and ancillary police department personnel.

Naloxone, which comes as in injectable or inhalable forms, is used to reverse opioid overdoses. Records show that law-enforcement officers in Arizona used it on average of once a day in the summer of 2017.(Photo: Getty Images)

The Mohave County doctors were not named. The data from the Arizona Board of Pharmacy's controlled substances prescription monitoring program database included total prescriptions and pill quantities by prescriber.

At least two Mohave County doctors have faced criminal charges from inappropriate prescribing in recent years.

In 2011, Albert Yeh, who operated a pain management clinic in Golden Valley, pleaded guilty to fraudulent schemes, illegal control of an enterprise and money laundering. Yeh surrendered his medical license, was sentenced to 2.5 years in prison and agreed to pay $683,000 in restitution.

Although the clinic in the small community west of Kingman was open one day a week, Yeh would see 100 patients in a day and prescribed powerful painkillers such as oxycodone, Percocet and Vicodin, court documents state.

More recently, federal prosecutors accused Dr. Shakeel A. Kahn, who operated pain-management clinics in Fort Mohave and Casper, Wyoming, of improperly prescribing large amounts of oxycodone and other drugs.

Kahn was charged in November with 21 federal counts relating to prescribing and distribution of drugs at clinics in Fort Mohave and Casper.

The federal indictment accused Kahn and four others in a conspiracy to dispense and distribute oxycodone, alprazolam and carisoprodol, resulting in the death of an Arizona resident, Jessica Burch, on March 19, 2015.

Kahn pleaded not guilty to all charges during an initial court appearance Nov. 28, 2017 at U.S. District Court in Wyoming. His attorney did not return a call from TheArizona Republic.

Pain management in rural areas

When pain-management clinics close in rural communities, it often leaves people scrambling for new doctors to meet their pain needs.

"It puts providers in a very challenging position," said Kimberly Chen, director of pharmacy for North Country Healthcare.

North Country is a community health center with more than a dozen locations across eastern and northern Arizona. It operates a trio of clinics in Mohave County, including a Kingman clinic with pharmacy access.

“The opioid epidemic is touching rural and urban areas, and all socioeconomic groups.”

Dr. Daniel Derksen, director of the Arizona Center for Rural Health

North Country is a primary-care clinic that does not employ pain doctors but often provides a bridge for patients until they are able to find a specialist. People in remote communities often have to drive an hour or two to reach a pain-management specialist. That problem may be exacerbated if a pain-management doctor abruptly leaves the community.

"It definitely leaves this sort of hole," Chen said.

Dr. Daniel Derksen, a University of Arizona professor and director of the Arizona Center for Rural Health, said he expects that Arizona's new opioid law, along with licensing board enforcement and improved data collection, will combine to root out any remaining pill mills.

Derksen said the governor's emergency declaration in June has provided more timely data on opioid overdoses and deaths. With more robust data, public health officials will be able to better target problem areas to improve results for patients, Derksen said.

"The opioid epidemic is touching rural and urban areas, and all socioeconomic groups," Derksen said.